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Table 1 Timeline of the case report

From: A compulsive act of excess water intake leading to hyponatraemia and rhabdomyolysis: a case report

Time pointClinical featuresInvestigationsManagement
2 weeks prior to hospital admission• Left-sided renal colicky type pain• Radiography—left mid ureteric calculus• Reassured and requested to consume plenty of water
2 days prior to hospital admission• Consumed about 10 l of water per day and developed polyuria, fever, dark urine, generalized weakness and altered level of consciousness• None• None
On the day of hospital admission• One episode of generalized tonic-clonic seizure
• Disoriented in place, person and time
• GCS—9 (motor—5, verbal—2, eye—2)
• Serum sodium—119 mmol/L
• Serum potassium—2.9 mmol/L
• Serum osmolality—242 mOsm/kg of water
• Urine osmolality—195 mOsm/kg of water
• Non-contrast CT brain—normal
• IV cefotaxime (2 g 6 hourly)
• IV acyclovir (500 mg 8 hourly)
• IV dexamethasone (2 mg 6 hourly)
• IV 3% hypertonic NaCl single bolus (100 mL over 20 min)
• IV KCl single infusion (40 mmol over 12 h)
• Fluid input per hour = previous hours output + 20 mL
Day 3• GCS—15 (motor—6, verbal—5, eye—4)• Serum sodium—136 mmol/L
• Serum potassium—3.8 mmol/L
• Creatinine phosphokinase—10,000 U/L
• Myoglobinuria—positive
• Fluid input per hour = previous hours output + 20 mL
• IV antibiotics continued
Day 4• Clinically stable• AST—2316 U/L
• ALT—463 U/L
• Fluid input per hour = previous hours output + 20 mL
• IV antibiotics continued
Day 5• Clinically stable• Serum osmolality—342 mOsm/kg of water
• Urine osmolality—869 mOsm/kg of water
• Fluid input per hour = previous hours output + 20 mL
• IV antibiotics continued
• IV dexamethasone omitted
Day 7• Clinically stable• AST—1383 U/L
• ALT—488 U/L
• Creatinine phosphokinase—54,841 U/L
• Normal fluid intake per day
• IV antibiotics continued
Day 9• Clinically stable• AST—702 U/L
• ALT—398 U/L
• Creatinine phosphokinase—18,070 U/L
• Normal fluid intake per day
• IV antibiotics continued
Day 11• Clinically stable• AST—240 U/L
• ALT—232 U/L
• Creatinine phosphokinase—1419 U/L
• Normal fluid intake per day
• IV antibiotics omitted
Day 15• Clinically stable• AST—66 U/L
• ALT—78 U/L
• Creatinine phosphokinase—49 U/L
• Discharged with appropriate medical advice to prevent similar complications